Association between English Proficiency and Kidney Disease Knowledge and Communication Quality among Patients with ESKD

Abstract

Background: End stage kidney disease (ESKD) is a chronic health condition for which communication between health care teams and patients is important to guide patient self-management activities. Yet little is known about quality of communication among patients with ESKD and their care team members. We examined the influence of patient’s LEP status on communication experiences at one dialysis center. Methods: A survey was administered to adults receiving ESKD care at a dialysis unit within a public health care delivery system between July 2022 and February 2023, to ascertain kidney disease knowledge and perceptions of communication quality with the dialysis care team. Multivariable logistic and ordinal logistic regression models adjusted for age and gender were used to determine associations between LEP status and CKD knowledge. Results: Among 93 eligible patients, 88.2% (n=82) completed the survey. Approximately 37.8% (n=31) had LEP, mean age was 58.8 years, 68.3% were men, mean dialysis vintage was 3.9 years, and 25% had a positive depression screen (LEP 30%; English-proficient 22%). A higher proportion of English-proficient patients screened positive for limited health literacy compared to those with LEP (74.5% vs 38.7%, p=0.002). Overall, knowledge of assigned cause of ESKD (53.4%) and CKD/transplant knowledge (57.3%) was suboptimal. After adjustment, LEP status was not significantly associated with knowing the correct cause of kidney failure (OR=0.49, 95% CI 0.19-1.27) but was significantly associated with having a higher score on a CKD/transplant knowledge scale (OR 3.99, 95% CI 1.66-9.58). Patients with LEP reported poorer communication quality with dialysis providers and staff (less listening, fewer clear explanations, less time spent with patients) compared to English-proficient patients, though differences were not statistically significant. Conclusions: Overall communication between patients with ESKD and members of the dialysis care team was suboptimal, regardless of English proficiency. Interventions to enhance communication for ESKD patients are needed.